| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,111 |
3,055 |
$125K |
| D0120 |
Periodic oral evaluation - established patient |
3,623 |
3,553 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,435 |
2,394 |
$63K |
| D9110 |
|
595 |
579 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,528 |
1,495 |
$27K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
422 |
347 |
$26K |
| D1351 |
Sealant - per tooth |
321 |
195 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
3,306 |
3,214 |
$19K |
| D1110 |
Prophylaxis - adult |
434 |
422 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,597 |
2,524 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
268 |
230 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
450 |
445 |
$10K |
| D0272 |
Bitewings - two radiographic images |
254 |
249 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
27 |
$388.80 |